cd8 dli for patients with relapse or residual disease following allogeneic stem cell transplantation

Conditions: Chronic Myelogenous Leukemia; Multiple Myeloma; Non Hodgkin's Lymphoma; Hodgkin's Disease; Chronic Lymphocytic Leukemia

Summary: primary objectives: to evaluate response rates of acute or chronic graft-versus-host disease (gvhd) following cd8 depleted dli (depleted donor lymphocyte infusions) in patients with chronic myelomonocytic leukemia (cmml), chronic lymphoid leukemia (cll), non-hodgkin's lymphoma (nlm), multiple myeloma (mm) and hodgkin's lymphoma (hd). secondary objectives: * to evaluate safety and treatment related mortality after cd8 depleted dli. * to evaluate the time to onset of gvhd following dli and response to gvhd treatment. * to evaluate the incidence and timing of pancytopenia following dli. * to evaluate disease-free survival, overall survival and relapse rates in three cohorts of patients; early relapse cml, late relapse cml and lymphoproliferative disorders (hd, cll, nhl and mm). * to evaluate the need and efficacy of second or subsequent cd8 depleted donor lymphocyte infusions. * to evaluate the number of apheresis procedures needed to collect appropriate doses of cd4+ cells.


Eligibility criteria:
* patients of any age who have previously undergone allogeneic hematopoietic transplantation and have evidence of donor cell engraftment (\>20% donor cell within three months of study entry) * expected survival \>4 weeks * cml patients with molecular, cytogenetic or hematologic relapse following allogeneic transplantation 1. molecular relapse- patients are eligible if bcr/abl is detectable at any time after day 180 post-allogeneic transplantation or if a negative bcr/abl pcr test was documented post-transplantation and the bcr/abl test is now positive by consecutive pcr determinations at least 4 weeks apart. 2. cytogenetic relapse-patients are eligible if standard cytogenetics demonstrate \>10% t (9,22) positive cells greater than 60 days after myeloablative transplantation or 10% t (9,22) positive cells greater than 100 days after nonmyeloablative transplantation. * cml patients with accelerated phase or blast crisis following allogeneic transplantation * patients with cll, nhl, mm, or hd who have evidence of disease relapse or persistent disease at 60 days post-allo bmt and/or: 1. mm- patients with a rising m-protein is detectable at 180 days post-transplant 2. nhl - patients with molecular evidence of disease (bcl-2, t (4,11), etc.) at 180 days post transplant 3. cll, nhl or hd - patients with clear cut evidence of tumor growth at any time post-transplant are eligible * patients undergoing an hla -identical or 5/6 antigen match transplant from a related or unrelated donor * patient's original donor must be available for lymphocyte donation * there must be no evidence of active acute or graft-versus-host disease and patients should be off all immunosuppressive agents for, at least, two weeks prior to dli. patients on stable dose of methylprednisolone (\<16 mg/d) without evidence of active gvhd are also eligible. * patients must have a zubrod ps\<2 (see appendix 7), cr\<2.5, bilirubin \<3, and transaminases (sgpt, sgot) \<4x normal * patient must be able to sign informed consent

Keywords: cml mm nhl hd cll cd8 depleted donor lymphocyte